NAME: XXXXXXXXXXXXXXXX BRANCH OF SERVICE: ARMY
CASE NUMBER: PD1200461 SEPARATION DATE: 20030411
BOARD DATE: 20130103
SUMMARY OF CASE: Data extracted from the available evidence of record reflects that this
covered individual (CI) was an active duty Soldier, SFC/E‐7(35W/Aviation Avionics Technician),
medically separated for Crohn’s disease, rated as moderate. The CI was diagnosed with Crohn’s
disease in 1997 by a civilian physician prior to entering the military. Due to persistent diarrhea,
she was deemed non‐deployable and unable to participate in physical training. The CI did not
improve adequately with treatment to meet the physical requirements of her Military
Occupational Specialty (MOS) or satisfy physical fitness standards. She was issued a permanent
P3 profile and referred for a Medical Evaluation Board (MEB). The MEB forwarded Crohn’s
disease as medically unacceptable IAW AR 40‐501. The MEB forwarded no other conditions for
Physical Evaluation Board (PEB) adjudication. The PEB adjudicated the Crohn’s disease as
unfitting, rated 10%, with application of the Veteran’s Affairs Schedule for Rating Disabilities
(VASRD). The CI made no appeals, and was medically separated with a 10% disability rating.
CI CONTENTION: The CI states: “Crohn’s disease is an uncurable illness, and the small intestine
resection performed while on active duty has had negative health side effects. Considering the
long term symptoms and their debilitating effects the service member should have been
medically retired.”
SCOPE OF REVIEW: The Board wishes to clarify that the scope of its review as defined in DoDI
6040.44 (Enclosure 3, paragraph 5.e. (2) is limited to those conditions which were determined
by the PEB to be specifically unfitting for continued military service; or, when requested by the
CI, those condition(s) “identified but not determined to be unfitting by the PEB.” The ratings
for unfitting conditions will be reviewed in all cases. Any conditions or contention not
requested in this application, or otherwise outside the Board’s defined scope of review, remain
eligible for future consideration by the Army Board for Correction of Military Records.
RATING COMPARISON:
VA (5 Mos. Post‐Separation) – All Effective Date 20030412
Service PEB – Dated 20021218
Condition
Code
Crohn’s Disease
7399‐7323
↓No Addi(cid:415)onal MEB/PEB Entries↓
Rating
10%
Condition
Crohn’s Disease
w/Polyarthralgia
Scar Residuals of Ileum
Resection
Code
7323
Rating
100%*
7804
10%
Exam
20030928
20030928
20030928
RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW
Combined: 10%
0% X 3 / Not Service‐Connected x 0
Combined: 100%
*Reduced to 30% on 7/1/09, reducing combined to 40%.
ANALYSIS SUMMARY: The Disability Evaluation System (DES) is responsible for maintaining a fit
and vital fighting force. While the DES considers all of the member's medical conditions,
compensation can only be offered for those medical conditions that cut short a member’s
career, and then only to the degree of severity present at the time of final disposition. The DES
has neither the role nor the authority to compensate members for anticipated future severity
or potential complications of conditions resulting in medical separation nor for conditions
determined to be service‐connected by the Department of Veterans Affairs (DVA) but not
determined to be unfitting by the PEB. However, DVA, operating under a different set of laws
(Title 38, United States Code), is empowered to compensate all service‐connected conditions
and to periodically re‐evaluate said conditions for the purpose of adjusting the Veteran’s
disability rating should the degree of impairment vary over time. The Board’s role is confined
to the review of medical records and all evidence at hand to assess the fairness of PEB rating
determinations, compared to VASRD standards, based on severity at the time of separation.
Crohn’s Disease. The CI first was diagnosed in the military with Crohn’s disease with bloody
diarrhea in 1998, and appropriate treatment initiated (Prednisone and Mesalamine). By
February 2000 the CI was doing well with controlled symptoms. A CT scan of the abdomen
obtained 2 May 2000 for increasing abdominal pain revealed active Crohn’s disease in the distal
small bowel and a large right ovarian cyst of questioned malignant origin. The CI was scheduled
for removal of the cyst in December 2001 by the gynecology service. At a pre‐operative surgical
clinic visit, the Crohn’s condition was mild with the CI having two to six bowel movements per
day without blood and occasional cramping abdominal pain.
At surgery performed on
11 December 2000, benign right and left ovarian cysts, not involving Crohn’s disease, and a
segment of distal small bowel and attached proximal colon, involving Crohn’s disease, were
removed. Post‐operatively the CI did well but manifested continued diarrhea, but with reduced
abdominal pain. Colonoscopy performed on 11 July 2001 demonstrated no evidence of residual
Crohn’s disease at the site of surgery. At the MEB/narrative summary (NARSUM) evaluation
performed on 25 November 2002, 4 months before separation, the CI reported 8 to 10 stools
without blood per day. The MEB physical exam noted blood pressure, pulse and temperature
were normal. Weight was stable with normal body mass index (BMI) of 21.5. Abdominal exam
was normal. The remainder of the clinical exam was unremarkable with no evidence of
malnutrition. Blood testing revealed no evidence of anemia. At the VA Compensation and
Pension (C&P) exam on 28 September 2003, 5 months after separation, the CI reported six to
seven loose stools a day without blood. She noted mild abdominal tenderness but, her health
to be good without recent weight loss or malnutrition. She noted the diarrhea to have a mild
effect on her functional activity. On physical examination vital signs were normal and the CI
noted to be in no distress. BMI was recorded as 22.7 (normal). The abdominal examination
was unremarkable and the stool free of blood. The remainder of the clinical exam was
unrevealing. Laboratory testing revealed no evidence of anemia.
The Board directs attention to its rating recommendation based on the above evidence. The
PEB and VA both rated the condition under code 7323, colitis, but at different ratings. The PEB
rated 10% citing moderate, chronic diarrhea. The VA rated at 100% citing six to seven loose
stools a day with marked malnutrition, anemia, general disability and serious complications.
Under this code a 10% rating requires moderate disease, with infrequent exacerbations. A 30%
rating requires moderately severe disease with frequent exacerbations. The 60% rating
requires severe disease, with numerous attacks a year, malnutrition, and health only fair during
remissions. The 100% rating requires pronounced disease, resulting in marked nutrition,
anemia, and general disability or with serious complications such as liver abscess. The Board
noted the CI to have six to seven stools a day without blood or abdominal pain and to be in
good general health at the time of separation. The Board noted the record to document no
malnutrition, anemia, serious complications, sepsis or flares of the disease requiring
hospitalization or treatment with additional steroid medications. The Board unanimously
agreed the preponderance of evidence supported the condition to be mild to moderate at the
time of separation. After due deliberation, considering all of the evidence and mindful of
VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to
recommend a change in the PEB adjudication for the Crohn’s condition.
2 PD1200461
BOARD FINDINGS: IAW DoDI 6040.44, provisions of DoD or Military Department regulations or
guidelines relied upon by the PEB will not be considered by the Board to the extent they were
inconsistent with the VASRD in effect at the time of the adjudication. The Board did not
surmise from the record or PEB ruling in this case that any prerogatives outside the VASRD
were exercised. In the matter of the Crohn’s condition and IAW VASRD §4.114, the Board
unanimously recommends no change in the PEB adjudication. There were no other conditions
within the Board’s scope of review for consideration.
RECOMMENDATION: The Board, therefore, recommends that there be no recharacterization of
the CI’s disability and separation determination, as follows:
VASRD CODE RATING
7399‐7323
COMBINED
10%
10%
Crohn’s Disease
UNFITTING CONDITION
The following documentary evidence was considered:
Exhibit A. DD Form 294, dated 20120531, w/atchs
Exhibit B. Service Treatment Record
Exhibit C. Department of Veterans’ Affairs Treatment Record
SFMR‐RB
XXXXXXXXXXXXXXXX, DAF
President
Physical Disability Board of Review
MEMORANDUM FOR Commander, US Army Physical Disability Agency
(TAPD‐ZB / XXXXXXXXX), 2900 Crystal Drive, Suite 300, Arlington, VA 22202‐3557
SUBJECT: Department of Defense Physical Disability Board of Review Recommendation for
XXXXXXXXXXXXXXX, AR20130000812 (PD201200461)
I have reviewed the enclosed Department of Defense Physical Disability Board of Review (DoD
PDBR) recommendation and record of proceedings pertaining to the subject individual. Under
the authority of Title 10, United States Code, section 1554a, I accept the Board’s
recommendation and hereby deny the individual’s application.
This decision is final. The individual concerned, counsel (if any), and any Members of Congress
who have shown interest in this application have been notified of this decision by mail.
BY ORDER OF THE SECRETARY OF THE ARMY:
3 PD1200461
.
‐
Encl
XXXXXXXXXXXX
Deputy Assistant Secretary
(Army Review Boards)
CF:
( ) DoD PDBR
( ) DVA
‐
4 PD1200461
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The bowel condition, characterized as “Crohn’s Disease” was the only condition forwarded to the Physical Evaluation Board (PEB) IAW AR 40-501.The Informal PEB adjudicated “Crohn’s disease”as unfitting, rated 10% with application of the Veterans Affairs Schedule for Rating Disabilities (VASRD).The CI made no appeals and was medically separated The Board’s assessment of the PEB rating determinations is confined to review of medical records and all available evidence for application of the...
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She was then medically separated with a 10% disability rating. Prior to Separation) Effective 19990304 Condition Code Rating Condition Code Rating Exam 20030429 TDRL Sep. Ileocolonic Crohns Disease w/ DJD 7399-7323 30% 10% Crohns Disease s/p ileocolonic resection 7323 30% 19990106 Inflammatory Arthritis Secondary to Crohns 5009-5002 20%* 19990106 and 20050301 .No Additional MEB/PEB Entries. The VA GI exam, approximately 9 months prior to separation, noted that the CIs...